Patient Service Rep III - Inpatient Specialty Program

Cedars Sinai Los Angeles , CA 90009

Posted 1 week ago

The Patient ServiceRepresentative supports the physician and clinical staff in the delivery ofhealth care by performing a variety of administrative related tasks to maintaina smooth and efficient front office workflow.

ESSENTIAL DUTIESAND RESPONSIBILITIES include thefollowing. Other duties may beassigned.
1.Greet patients.
2.Collect co-payments/give receipts/reconcilepayments/batch fee tickets.
3.Prepare charts.
4.Review patient demographics and insuranceinformation.
5.Perform/update demographics and insuranceregistration.
6.Collect co-pay/insurance cards, copying requiredinformation.
7.Manage patient flow.
8.Maintain waiting rooms.
9.Schedule first available appointments.
10. Takevoice mail messages off phones and direct appropriately.
11. Answerand triage calls, directing to appropriate individuals or departments.
12. Handleall telephone interactions.
13. Performcheck-in and check-out functions.
14. Processand track referrals.
15. Handlepatient/MD correspondence.
16. Manageall MD requests.
17. Schedulepatients with ancillary and specialty providers.
18. Abilityto train all PSR-I and PSR-II.
19. Respondto patient questions and complaints.
20. Monitorwork flow/review morning and afternoon tasks.
21. Assistin work assignments.
22. Reportperformance issues to supervisors.
23. Recommendareas for improvement.
24. Interface/liaisonwith other departments.
25. Assistin meeting/auditing.
26. Distribute patients to variousrounding teams, using set of guidelines. Requires rudimentary understanding ofmedical terms to appropriately cohort patients.
27. Respond to email requests forupcoming patient admissions. Includes:

a. replying to emails regarding newconsults/admissions, upcoming surgical cases, upcoming direct admits, SNFtransfers

b. Adding those patients to EMR andmemos
28. Keep track of daytime pendingadmissions, to assign admits to hospitalist on-deck for next admission (keepingin mind cohorting list guidelines)
29. Provide backup coverage for otheradministrative assistants
30. Other duties as assigned

Educational Requirements:

High school diploma orequivalent.

1.3-6 years experiencepreferred.
2.Proventrack record with customer service and practice operations.
3.Abilityto teach others about medical terminology and insurance concepts.
4.Workingknowledge of master schedules and templates.
5.Intermediate computerexperience.
6.Experience with heavy phone volume.
7.Ability to problem solve/prioritize.
8.Advanced knowledge of medical terminology andinsurance concepts (ability to problem solve and assist patients).
9.Ability toschedule using summary search.
10. Be able todifferentiate between CSMG & CSHA, HMO, PPO, and POS; be able to followP&P accordingly.

  • Working Title: Patient Service Rep III - Inpatient Specialty Program

  • Department: ISP

  • Business Entity: Medical Network Foundation

  • City: Los Angeles

  • Job Category: Administrative

  • Job Specialty: Admissions / Registration

  • Position Type: Full-time

  • Shift Length: 8 hour shift

  • Shift Type: Full-time

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Case Manager Inpatient Specialty Program

Cedars Sinai

Posted 2 days ago

VIEW JOBS 3/16/2019 12:00:00 AM 2019-06-14T00:00 The RN, Case Manager conducts case management on patients in the inpatient, intensive outpatient, residential care and Skilled Nursing Facility settings. CSMNS has developed a case management program that is geared towards the management of patients while hospitalized and upon discharge from various care settings. Using the Case Management Society of America's (CMSA) model, we describe our approach as "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes." In collaboration with the Inpatient Specialty Program (ISP) hospitalists (physicians who practice hospital medicine), the program is designed to assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs, coordinating care, communicating with health plans (including concurrent review, which assists the hospitalist/specialist and case manager to determine the appropriateness of services rendered and to ensure that quality care is delivered in a cost-effective manner), and referring to disease management programs and ambulatory case management (focus is on those members requiring complex and/or chronic care for follow up after discharge). Decisions regarding care are made within one working day of obtaining all necessary information. ESSENTIAL JOB DUTIES: 1) Care manager meets with patients within 24 hours of admission and conducts an initial assessment. 2) Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient's stay a) Review with hospitalist the patient's admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. b) Begin discharge planning and care assessment within one working day (preferably on day of admission). 3) Submit necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate. 4) For patients who are transitioning to the Skilled Nursing Facilities, refer to nurse practitioner and case manager assigned to the SNF's for continued review and follow up. a) Physician will be notified of such a transition within 24 hours of admission to the specified facility. b) Transition of care will be communicated to the member or responsible party at least 1 day prior to the transition, which includes information pertaining to: i) Transition process and what to expect ii) Changes in health status and the care plan iii) Staff who will be handling issues, questions, concerns, i.e. Case Manager, Social Worker, Nurse Practitioner. 5) Case Manager will wear appropriate CSMNS employee badge: all rules and policies of the facility will be followed while on-site. 6) If admission is to a non-contracted facility, determine if patient is stable for transport and transfer back in-network. 7) Authorize all appropriate services based upon covered benefits and necessity of care provided in the: a) Member's home or residence b) Acute Care c) Skilled Nursing Facility d) Rehabilitation Facility e) Home Health Care f) Custodial Care facility or Board and Care Facility 8) Coordinate discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate. a) After hours, the on-call case manager support that is an invaluable resource to both the patients and the physicians. b) Coordinate the patient's care with other health care personnel to ensure that the patient receives care timely post discharge. 9) Secure outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers 10) Referral to Ambulatory Case Manager for those patients identified that will need oversight of outpatient care and compliance to avoid unnecessary re-admissions 11) Coordinate referrals and secure appointment with various CSMNS disease management programs such as anticoagulation clinic, Asthma, Diabetes, Hepatitis C, smoking cessation, cardiovascular risk reduction and nutrition, as appropriate 12) Enter and update all authorization and clinical information into Nautilus (Access Express) no later than date of discharge. Educational Requirements: Graduation from an accredited school of nursing. License/Certification Requirements: Current and valid California RN licensure. Experience: * 3-5 years of acute nursing experience * Knowledge of medical/nursing standards of care * Ability to effectively communicate and collaborate with physicians, patients/families, and ancillary staff to make sound, independent judgments and to act professionally under pressure * 1-2 years of previous experience in case management in the acute inpatient or outpatient settings * Knowledge of HMO and Medicare rules in inpatient, home health and at the SNF settings. Preferences: Preferred candidates are Certified Case manager (CCM) certification for RN's, utilization review (UR) experience, and minimum of BSN (Bachelor of Science degree in Nursing). * Working Title: RN Case Manager - Inpatient Specialty Program * Department: MNS ISP * Business Entity: Medical Network * City: Los Angeles * Job Category: Patient Services * Job Specialty: Case Management * Position Type: Full-time * Shift Length: 8 hour shift * Shift Type: Day Cedars Sinai Los Angeles CA

Patient Service Rep III - Inpatient Specialty Program

Cedars Sinai